Background

Many consider the Roux-en-Y gastric bypass (RYGB) the gold standard in bariatric surgery. Many patients, however, experience weight regain or never achieve their ideal weight following surgery. The biliopancreatic diversion with duodenal switch (BPD-DS) is a more malabsorptive procedure than the RYGB and has been shown to have a more robust weight loss and better long-term results when compared to the RYGB. We retrospectively evaluated our experience of conversion from RYGB to BPD-DS over the last 5 years

Methods

Four surgeons performed elective conversion of RYGB to BPD-DS on 183 patients at our institution from 2015 to 2021. Electronic health records were reviewed retrospectively for preoperative comorbidities, weight and outcomes at the time of surgery and at one year postoperatively.

Results

Of the 183 patients who underwent a one stage conversion of a RYGB to a BPD-DS, 169 were followed for a year. In the first 30 days, 16 patients had one or more complications. This includes: 6 with a GI bleed, 3 Small bowel obstructions, 3 with leaks, 6 with a wound infection or abscess. The average weight loss at one year was 71.7 pounds and the average BMI point change was 11.7 k/gm2.

Conclusions

For those patients who have had RYGB and postoperatively develop weight recidivism or do not achieve adequate weight loss a conversion to a duodenal switch may be a viable option. Outcomes with weight loss were considerable at a year. This is the largest cohort of RYGB revision to BPD-DS to date.